The adjudication of a claim is one of the primary functions of an adjudication engine, which is done according to a predefined insurance plan. At the heart of the adjudication process is the execution of business rules to determine the eligibility of a claim and its parts (with respect to the plan), and if the parts are eligible, what amount should be paid. However, there currently exists insurance plan schemes that do not allow for flexibility and individuality of insurance plan design and maintenance. For example, two people with the same general set of plan attributes but with a few slightly different maximums and frequencies would have to have individual plans constructed for each of them, involving separate people and benefit models with associated rules. This process of designing two separate plans is undesirable, as there would be a fair amount of duplication in the resultant individual benefit and people models and associated rules. There is a further disadvantage with current insurance plan models for defining conflict resolution, since the execution order of complicated sets of rules is typically rigid in assignment.
It is an object of the present invention to provide a system and method for defining a flexible insurance plan for the purpose of adjudication to obviate or otherwise mitigate at least some of the above presented disadvantages.